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To evaluate the safety and efficacy of neoadjuvant radiohormonal therapy for oligometastatic prostate cancer (OMPC), we conducted a 3 + 3 dose escalation, prospective, phase I/II, single-arm clinical trial (CHiCTR1900025743), in which long-term neoadjuvant androgen deprivation was adopted 1 month before radiotherapy, comprising intensity modulated radiotherapy to the pelvis, and stereotactic body radiation therapy to all extra-pelvic bone metastases for 4-7 weeks, at 39.6, 45, 50.4, and 54 Gy. Robotic-assisted radical prostatectomy was performed after 5-14 weeks. The primary outcome was treatment-related toxicities and adverse events; secondary outcomes were radiological treatment response, positive surgical margin (pSM), postoperative prostate-specific antigen (PSA), pathological down-grading and tumor regression grade, and survival parameters. Twelve patients were recruited from March 2019 to February 2020, aging 66.2 years in average (range, 52-80). Median baseline PSA was 62.0 ng/mL. All underwent RARP successfully without open conversions. Ten patients recorded pathological tumor down-staging (83.3%), and 5 (41.7%) with cN1 recorded negative regional lymph nodes on final pathology. 66.7% (8/12) recorded tumor regression grading (TRG) -I and 25% (3/12) recorded TRG-II. Median follow-up was 16.5 months. Mean radiological progression-free survival (RPFS) was 21.3 months, with 2-year RPFS of 83.3%. In all, neoadjuvant radiohormonal therapy is well tolerated for oligometastatic prostate cancer.
Subject(s)
Male , Humans , Prostatic Neoplasms/radiotherapy , Prostate-Specific Antigen/therapeutic use , Neoadjuvant Therapy , Androgen Antagonists/therapeutic use , Prospective StudiesABSTRACT
Introduction: Oligometastatic represents a distinctive subset of metastatic breast cancer (MBC). Incidence has been reported, in 1–5% of all newly diagnosed MBC. Literature is very sparse, especially from India. Material and Methods: We have ambispectively screened 500 patients of upfront female MBC between the period of January 2013 and August 2018 at Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi and 120 patients of oligometastatic breast cancer (OMBC) were included for analysis. Clinical, pathological, receptor status (ER estrogen receptor, PR progesterone receptor, and HER2/neu human epidermal growth factor), radiological, treatment, and survival details were recorded. Results: The median age of presentation was 50 (range 22–78) years. One organ was involved in 96 (80%) patients, and two organs were involved in 36 (20%) patients. ER and/or PR was positive in 48 (40.0%), ER/PR, and HER2/neu were positive in 28 (23.3%) cases. Only HER2/neu was positive in 21 (17.5%), and triple negativity was seen in 23 (19.2%) patients. Ninety?four (78.3%) patients received neoadjuvant therapy, and 12 (10%) patients underwent conservative breast surgery. The overall response rate at the metastatic site was 74.1%, and a complete response was seen in 42.5% of patients. Median progression?free survival (PFS) for the cohort was 25.43 months. The estimated PFS at 2 years and, at 5 years, was 54.6% and 21.6%, respectively. The hormone receptor positivity, bone metastasis, and patients with surgery after neoadjuvant chemotherapy (NACT) had a statistically significant better PFS on multivariate analysis. In a subset analysis of HER2/neu receptor?positive patients, who received targeted therapy showed better PFS compared to those who did not receive. Conclusion: The incidence of OMBC is 24% of the total MBC. The patients with OMBC who have hormone receptor?positive, bone?only metastasis, and surgery after NACT show a better outcome.
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Previous studies believe that oligometastasis has unique biological characteristics. Early active treatment for patients with oligometastatic prostate cancer can delay disease progression and improve survival. However, the current definition of oligometastasis is still unclear, and its optimal treatment is still a major concern of the medical community. This article reviewed recent research progresses in term of the definition and comprehensive treatment strategy of oligometastatic prostate cancer.
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Conclusion:Patients with OlimHSPC who are not sensitive to traditional CAB treatment, ADT combined with abiraterone acetate neoadjuvant therapy and postoperative adjuvant therapy can be attempted.
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@#Presented here is a 66 year old male who is a known case of prostate adenocarcinoma gleason score 9 (4+5) and who underwent open radical retropubic prostatectomy with bilateral pelvic lymph node dissection, followed by 45 cycles of radiation therapy with continous androgen deprivation therapy. Afer completion of radication therapy, Choline PET CT was done which revealed enlarged paracaval, aortocaval and paraaortic lymph nodes. The patient then underwent exploratory laparotomy, retroperitoneal lymph node dissection which found four out of twenty five lymph nodes removed that were positive for tumor metastases. There was a significant drop in the prostate specific antigen level two months post-surgery, from 7.43 to 1.54. Androgen deprivation therapy was still continued post-operatively.
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Es indudable que el cáncer de próstata es objeto de permanente investigación dada su alta prevalencia y morbimortalidad asociada. Sin embargo, el cáncer oligometastásico reconocido como una entidad aparte, es un tópico ha ido ganando interés durante los últimos años. Se ha propuesto que el cáncer oligometastásico podría ser considerado una etapa previa al cáncer metastásico avanzado, dada su evolución más indolente, permitiendo plantear nuevos cursos de tratamiento y nuevos enfrentamientos terapéuticos, que los utilizados en etapas más complejas. En este trabajo se realizó una revisión no-sistemática de la literatura actual respecto al rol de la cirugía en el cáncer oligometastásico, para esto se utilizaron las bases de datos Pubmed y MGH Treadwell Library, con limites dentro de los últimos 10 años además de publicaciones en las revistas Journal of Urology y European Urology. Se revisaron bases de datos chilenas reportadas en Datos Estadísticos e Información en Salud (DEIS). Históricamente, el tratamiento estándar para cáncer de próstata metastásico ha sido el tratamiento paliativo a largo plazo con terapia de deprivación de andrógenos (ADT). Sin embargo, basado en el comportamiento particular que presentaría el cáncer de próstata oligometastásico, se han realizado estudios en los que la cirugía cada vez juega un rol más protagónico. Los nuevos datos son altamente sugerentes que la cirugía podría representar una modalidad terapéutica útil en el manejo de cáncer de próstata oligometastásico. Sin embargo, aún es necesario definir protocolos respecto al manejo de esta entidad y se requieren mayores estudios para definir cuál sería la mejor forma de lograr resultados o si presentaría beneficio asociar el manejo quirúrgico a otras terapias complementarias. AU
There is no doubt that prostate cancer is subject of permanent research because of its high prevalence and associated morbidity and mortality. However, oligometastatic cancer as a particular entity, is a topic that has been gaining interest over the past few years. It has been proposed that oligometastatic cancer could be considered a stage prior to advanced metastatic cancer, given its more indolent course, allowing to consider if there would be benefits in new therapeutic approaches than those used in more advanced stages. In this paper, we performed a non-systematic review of the current literature regarding the role of surgery in oligometastatic cancer, using Pubmed and MGH Treadwell Library databases with limits within the last 10 years. And also, publications in journals as "European Urology" and "Journal of Urology". Chilean databases reported in "Datos Estadísticos e Información en Salud" (DEIS) were reviewed. Historically, the standard treatment for metastatic prostate cancer has been long-term palliative treatment with androgen deprivation therapy (ADT). However, based on the particular behavior of oligometastatic prostate cancer, studies have been performed in which surgical treatment is playing a more prominent role. The new data is highly suggestive that surgery could represent a useful therapeutic modality in the management of prostate cancer. However, it is still necessary to define protocols regarding the management of this entity and more studies are required to achieve this and define what would be the best way to accomplish results or whether it would be beneficial to associate surgical management with other complementary therapies.AU
Subject(s)
Male , Prostatic Neoplasms , Prostatectomy , General SurgeryABSTRACT
Objective To determine the effectiveness and safety of stereotactic body radiotherapy (SBRT)-CyberKnife for oligometastatic prostate cancer.Methods From May 2012 to February 2017,31 patients treated by CyberKnife were retrospectively reviewed,with a median age of 67 years(range 52 to 83 years),including 50 oligometastatic and 2 primary prostate cancer patients.The median PSA level was 8.4 ng/ml(range 0 to 300.0 ng/ml) and PSA test was performed every month.PSA progression-free survival (PSA-PFS),time to initiation of androgen deprivation therapy (ADT) and local control rate (LCR) were measured as the main outcomes.Results SBRT was well tolerated and were performed as planned in all patients.No SBRT related acute or late toxicities were observed.No bone fracture was observed in patients treated by bony targeted radiotherapy.The median follow-up after SBRT was 20.7.months (range 1.2-58.3 months).The median PSA-PFS was 5.3 months (range 0-58.3 months).1-year,2-year,and 4-year PSA-PFS was 52.0％,36.7％ and 36.7％ respe ctively.PSA level decrease was observed in 21 oligometastatic prostate cancer patients after SBRT,with median PSA-PFS of 12.3 months (range 1.2-58.3 months).PSA level increase was observed in 29 oligometastatic prostate cancer patients after SBRT.Six local recurrence were observed resulting in an actuarial 1-year,2-year and 3-year LCR of 90.4％,86.9％ and 82.6％,respectively.Twelve patients treated without ADT after SBRT,with median follow-up of 8.6 months (range 2.9-58.3 months) in this subgroup.Seven patients were added ADT after SBRT,with the median time from SBRT to initiation of ADT of 13.3 months (range 3.0-24.0 months) in this subgroup.Twelve patients were treated with ADT continuously after SBRT.Conclusions CyberKnife seems to be a safe and effective treatment with tolerated adverse events and good local control for patients with oligometastatic prostate cancer.
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There is no clear consensus for the best treatment of men with locally advanced prostate cancer. As a first step, radiation therapy or primary hormone therapy or radical prostatectomy with extended pelvic lymph node dissection is used. But it seems impossible to have a good oncologic result with single treatment modality. Traditionally, external beam radiation therapy with adjuvant hormone therapy is most preferred treatment method in locally advanced prostate cancer and radical prostatectomy has not been routinely used because of high rates of margin positive and lymph node metastasis. But, recently published articles showed that surgery in multimodal setting is effective treatment modality and not inferior to radiation therapy in oncologic outcomes. Perioperative morbidities of surgery and incontinence rates are similar to surgery of organ confined diseases, and patients with primary radiotherapy seem to have high rate of lower urinary tract symptoms and radiation related complications compared with radical prostatectomy with adjuvant radiotherapy. There is still controversy in regard to performing surgery for locally advanced prostate cancer. We review the studies with surgery in locally advanced prostate cancer and compare with radiation therapy in multimodal setting, and review the studies with surgery in oligometastatic prostate cancer.
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Humans , Male , Consensus , Lower Urinary Tract Symptoms , Lymph Node Excision , Lymph Nodes , Methods , Neoplasm Metastasis , Prostate , Prostatectomy , Prostatic Neoplasms , Radiotherapy , Radiotherapy, AdjuvantABSTRACT
Objective To evaluate the efficacy and safety of consolidation chemotherapy after thoracic radical concurrent chemoradiotherapy for patients with oligometastatic non?small cell lung cancer ( NSCLC) . Methods Sixty?six NSCLC patients with more than five metastases from 2008 to 2013 were enrolled, and image?guided radiotherapy with conventionally fractionated or hypofractionated doses were performed for these patients. Platinum?based doublets chemotherapy was applied for both concurrent chemoradiotherapy and consolidation chemotherapy. Short?term outcome, adverse reactions, and survival rate were assessed for the patients after treatment. Results Sixty?four patients completed the treatment. The median biologically equivalent dose for planning target volume of thoracic primary tumor lesions was 72 Gy, with a median number of chemotherapy cycles of 4. The objective response rate for thoracic lesions was 70%. The follow?up rate was 97%. The 1?, 2?, and 3?year overall survival ( OS) rates were 72%, 53%, and 31%, respectively, with a median OS time of 25 months;the 1?, 2?, and 3?year progression?free survival ( PFS) rates were 56%, 26%, and 7%, respectively, with a median PFS time of 14 months. The incidence of grade 2?3 acute radiation pneumonitis and radiation esophagitis was 1% and 17%, respectively, and the incidence of grade 3?4 decreases in leukocytes, hemoglobin, and platelet count was 39%, 11%, and 16%, respectively. Conclusions Radical radiotherapy combined with concurrent and consolidation chemotherapy for oligometastatic NSCLC can achieve good short?term outcome and long?term survival, with tolerable adverse effects.